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GPs need extra time to provide better services for these patients EDITOR--In his personal view Sellar advocates the development of a general practitioner for people with an intellectual handicap.[1] He [...]

EDITOR--Bolsover's report on the unsympathetic treatment of a doctor by medical colleagues after a mental health breakdown[1] has many parallels with a national study of our nursing colleagues, which was [...]

Medical education must reassert its claim to academic high ground EDITOR--Ham and Alberti place the current crisis in medicine in context. (1) Let us hope that the public, the profession, [...]

EDITOR--Smith is correct in saying that indifference to the social impact of research has produced a serious imbalance in the research portfolio. (1) Reporting on my own field, public health, [...]

Opportunities for nurses to become involved in public health work in the UK are discussed. A public health professional must now be present on the executive committee of all primary care trusts, and this has created very attractive career prospects for senior nurses who show strong leadership skills.

EDITOR--Last month the prime minister, Tony Blair, lent his weight to random drug testing in schools in an interview for a downmarket newspaper. (1) He proposed a national programnae be [...]

Selecting for extreme personality types is perilous EDITOR--Pit bull terriers and other hard to accommodate fighting dogs can be bred selectively in a remarkably few generations. Across the diversity of [...]

Maybe midwives were too busy EDITOR--Dobson reports that deliveries by caesarean section in England rose from 4% in 1970 to 19% in 1999. (1) Potentially, this created substantially increased demand [...]

This new series provides an overview of a selection of relevant public health research and comments on the findings and methods. This month, Woody Caanlooks at four articles focusing on improving mental health and wellbeing, and reducing health inequalities.

Aims: To examine whether the observed diversity between national patterns of smoking prevalence could require modification of the World Health Organization (WHO) linear model for an international `smoking pandemic' (a worldwide epidemic) to address data from non-western countries.Method: We conducted secondary research using current measures in three publicly available databases: Globalink, the International Labour Organization and the World Bank (all internetaccessible). The measures we used are the separate percentage data for men and women on: smoking and employment and national income per capita (US$) and percentage growth per annum.Results: Regression analysis showed that women smokers were more frequent in countries with higher national income, but women were less likely to smoke in countries of rapid growth. Men were less likely to smoke in countries with higher national income, but more likely to smoke in countries of rapid growth. Two principle components together explained 62% of all the variance in the international data. The largest factor was positively correlated with the percentage of employed females, the percentage of female smokers and national income per capita, but negatively correlated with the percentage of male smokers and percentage annual growth. The effect of female employment was not continuous, but above a threshold of 51%, was associated with a higher prevalence of female smoking. The smaller, second factor was only weakly correlated with any smoking variables.Conclusions: In his 1994 model (subsequently adopted by the WHO) Lopez looked at historical trends in `stages' of smoking prevalence. These have been associated with `stages' of economic development. We extended this analysis to look at a dynamic change (% annual growth) and a social indicator (employment). Male and female smoking is affected differentially by economic change and by level of income. These are also strongly related to the percentage of women in employment. This has implications for workplace policies on smoking.

Valuing People: A New Strategy for Learning Disability for the 21st Century(Department of Health, 2001a,b) aimed to introduce ‘health facilitation’ to improve the identification of health needs and access to appropriate care for people with learning disabilities. One London Borough took a leading role in implementing this new function, in the form of dedicated, full-time health facilitators. The authors examined the implementation and its impact, employing an innovative collaboration between professionals from practice, education and research. The clinical nurse involved was observed during her first year of health facilitation. The authors evaluated her impact on professionals, people with learning disabilities and the wider system of health. In some areas (for example, information technology) the health facilitator could make little progress in one year. However, she connected with a widening circle of local people and services, for example, in introducing health action plans for adults with a learning disability. Across the Borough some professionals became more aware of specific health issues in their local population.

This investigation explored the impact of alcohol on sexual behaviour in relation to the possible increased risk of chlamydia trachomatis. A sample of 208 women were recruited aged 16–24 years who had been tested at a pilot site for the national chlamydia screening programme. This formed a prospective community case series using questionnaires, case note review and focus groups. Eight women took part in the focus group discussions. The questionnaire contained quantitative details of past and present alcohol use (e.g. ‘binge-drinking’) sexual behaviours and partners and beliefs related to chlamydia. The results of chlamydia screening and the answers to a question about having had treatment for chlamydia were grouped in relation to alcohol use. The main findings were that three variables were associated with increased risk of chlamydia. These were age at which they first drank alcohol; number of lifetime partners and alcohol consumed on a ‘heavy’ night by the sub-group who displayed binge-drinking.

Rationale:Doctoral training should provide insight into the evolution of research capability in nursing.Methods:Research designs were evaluated from abstracts of 204 theses extracted from the ASLIB database, 1983–2002. Most were from PhD/DPhil degrees, but a few were Professional Doctorates.Findings:‘Educational’ and ‘organisational’ settings dominated, indicating their sustained popularity. A total of 11 methodological frameworks were noted, with ‘Ethnography’, ‘Social history’, ‘Work environment’ and ‘Grounded theory’ being the most popular. ‘Interviews’ with individuals and ‘Questionnaire survey’ were easily the most popular of 28 different research tools/techniques.Comparing abstracts from 1997–2002 with those from 1983–1996 identified significant changes in methodologies and methods used. The frequency of ‘Phenomenology’, ‘Work environment’ and ‘Grounded theory’ methodologies increased. The ‘Patient led’ framework appeared for the first time, albeit in just a few theses. The incidence of ‘Ethnography’ declined. Some methods only appeared for the first time during the 1990s, e.g. ‘Focus groups’. Of the methods, ‘Interviews’ increased substantially but ‘Questionnaires’ decreased slightly. In terms of developing clinical research, we noted an increased frequency of ‘All experimental’ methods. Multiple methods, used in 71% of theses overall, increased in incidence during the late 1990s, a change that was significantly associated with ‘post-1992’ universities. Over time, there was a significant increase in the number of methodologies and methods used, per thesis.Conclusions:This study documents the breadth of research designs used by students researching nursing. It provides evidence for an evolution of designs with an increasing diversity that indicates a growing maturity of nursing research culture.

This is a preliminary report on a quality improvement project for people with learning disabilities (PWLD) in one London Borough. The strategy document Valuingpeople required the implementation of a specific activity at two levels: both organizational development and individual health action plans. This activity was called health facilitation. It was left to local services to introduce health facilitation either by extension of existing roles or by creation of new specialist posts. Using neighbourhood renewalfunding to improve access to health services, Barking and Dagenham chose to create new posts. This paper will focus on just one of these innovative posts, linked to improving transition planning for school leavers with learning disabilities. There was a pressing local need to improve continuity of care between child and adult services. Multiple methods were used to investigate this new Health Facilitator (HF) role. The HF carried out both service development and person-toperson work, with a wide variety of contacts. Developing ‘signposting’ and appropriate referral systems for young people led to improved access to adult services. In general, this developmental role was seen as making a positive contribution in addressing the gaps in current services for young PWLD. The findings of this evaluation have already led to changes within local services and shaped future workforce planning.

A research questionnaire was developed in an area that had previously identified a shortage of general practitioners. This questionnaire was completed at multiple sites by 43 staff - a mix of doctors and nurses in two primary care trusts

The children’s disability team in Cambridge provides an integrated health and social care service for children with complex learning and physical disabilities and their families. The team uses a multidisciplinary and multi-agency teamwork approach to care provision. The effectiveness of the team was evaluated using a cooperative review of its functions, in which all the ‘subjects’ were active participants in defining and delivering the evaluation. This was combined with individual questionnaires regarding the team’s perceived strengths and weaknesses. Particular implications for training and supervision emerged from the findings. This article discusses the ways in which the team has successfully refined its practice of collaborative working in a developmental way between 1992–1998.

The major goal of therapy for many older people in a rehabilitation ward is discharge to their home. A retrospective study of former inpatients found that there were a variety of positive and negative outcomes to discharge. It was found that there was an association between indicators used both at admission and discharge and the success of post-rehabilitation outcomes.

This article focuses on the application of occupational therapy in the treatment of people with addictive behaviours. Furthermore it looks at how using a framework for service organization promoted the effective integration of occupational therapy into the multidisciplinary treatment provision. This is illustrated with a specimen group programme and two case studies.

Health inequalities are a major concern of the UK government which provides a good opportunity to look at the equity of access to health services for people with learning disabilities. To investigate how the whole system of care can be improved, this article will focus on a common problem that spans both primary and secondary care: heart disease. It uses access to a potentially life-saving procedure, the coronary artery bypass graft, as an indicator of equity. Opportunities can arise for nurses to overcome inequality for their clients, e.g. through nursing involvement in commissioning by primary care groups.

Woody Caan, a strong supporter of school nursing, explains why he believes school nurses have a vital role to play in the health and wellbeing of children and young people.

Formal postgraduate training curricula must be delivered effectively and efficiently. This survey identifies the learning situations trainees prefer and the elements that constitute a learning experience. Greater understanding of these factors may help tutors plan more effective teaching and learning opportunities.

There is an impressive potential for midwives (working in a variety of settings) to improve health, especially for the most disadvantaged individuals, families and communities. Skills within midwifery could advance public health in relation to: conception, pregnancy, birth, infancy, parenting and supporting families. However, there is little ‘evidence base’ for developing and deploying these midwifery skills safely, responsibly and effectively. New opportunities are arising for research to underpin the public health role of the midwife. This could also be the time for midwives to take on a leadership role in the research agenda, to advance their knowledge of how to benefit health across populations.

The Executive's latest R & D initiative, the Service Delivery and Organisation programme, has major implications for improving the knowledge base for managers. This article identifies the main issues and why managers should play a key role in its development.

Few studies have investigated the outcomes of chiropody treatment, especially in a large community sample. There is an increasing need for research in this field. Podiatrists and other professionals allied to medicine need the evidence from research to back up their opinions within health care. Collaboration between clinicians and higher education is critical for success.

Several letters to the editor are presented in response to articles in previous issues, including "Is Your University a Good Place to Work?" published in the January 30, 2014 issue, "Clock Is Ticking: Teenagers Question Sustainability of Free Tuition" in the February 6, 2013 issue, and "Tried and Tested: For How Long Do Research Papers Remain Useful?" January 30, 2014 issue.

The author advises British academics to join the medical sector in standing against Great Britain's health and social care bill before the British National Health Service (NHS) is dismantled. He points out how NHS contracts serve as major sources of funding for universities who offer medical courses and an access to NHS health professionals who volunteer to teach. He adds that privatizing health care will not provide the same range of learning opportunities as those supplied by NHS providers.